Welcome to Mi Casa Resource Center!

We would like to ask some questions about you and your household. The information you provide will be kept confidential and used by Mi Casa to serve you better. Providing us this information allows us to continue to offer free and low-cost services to you and the rest of the community. Please answer all questions to the best of your knowledge.

If you do not know your annual income for a category, please enter the amount you make/receive on a weekly, bi-weekly, or monthly basis in the category box and select that frequency.Si no sabes su ingreso anual para una categoría, ingrese la cantidad de ingresos semanal, quincenal o mensual y elige esa frecuencia para la categoría.

Wage EmploymentEmpleo formal

FrequencyFrecuencia

Calculated Wage Income

Self-EmploymentAuto empleo

FrequencyFrecuencia

Calculated Self-Employment Income

Child Support/AlimonyManutención de menores

FrequencyFrecuencia

Calculated Child Support Income

Friends or FamilyAmigos o Familia

FrequencyFrecuencia

Calculated Friends or Family Income

Government AssistanceAsistencia del gobierno

FrequencyFrecuencia

Calculated Gov't Assistance Income

Retirement or InvestmentJubilación o inversión

FrequencyFrecuencia

Calculated Retirement Income

Your annual person income is / Su ingreso personal anual es:

If this number is not correct, please adjust the income categories above / Ajuste las categorías anteriores si este número es incorrecto

Work Schedule/Horario de trabajoHealth/SaludChildcare/Cuidado de niñosSchool/ColegioFamily/FamiliaVacation/VacacionesTransportation/TransporteOther/OtroPlease mark all that may apply, and explain why below./Marque todo lo que corresponda y explique a continuación.

Explain/Explique

14. Outside of your business are there additional supports you need in place to be successful?/Fuera de su negocio, ¿hay apoyos adicionales que necesita para tener éxito?